We have further explored the merits of a newly developed system that can provide respiratory assistance in patients with severest forms of acute respiratory failure (ARF), and adult respiratory distress syndrome (ARDS). The fully integrated system contains a continuous positive airway pressure (CPAP) system, a newly developed low resistance endotracheal tube, and an original ITPV (intratracheal pulmonary ventilation) system to greatly reduce dead space ventilation. We have shown in a controlled studies that when the new system/method was applied to an experimental animal population with induced ARF/ARDS, there was progressive improvement in lung function with eventual weaning to room air breathing. All animals in a control group of sheep managed with conventional, state of the art ventilator care died of progressive respiratory failure, and cardiovascular collapse. These studies emphasize the importance of lung management during all stages of spontaneous/induced ARF. Recovery from severe ARF/ARDS through the use of this system suggests early application of these concept to avoid escalating from mild forms of ARF/ARDS, to more life threatening forms not amenable to treatment.